Women’s health is a vital category for pharmacy. “Women’s health is very important,” says LloydsPharmacy pharmacist Anshu Bhimbat. “In fact, it’s one of our main areas. Women tend to be our main customers and they buy for the whole family, but we often find that they neglect their own health.”
A large proportion of your customer base is likely to be women. “They will often visit throughout different stages of their life and the range of problems will be varied, from sexual health, contraception, pregnancy and period problems to thrush, cystitis and menopause symptoms,” says Cathy Crossthwaite, marketing co-ordinator at Numark.
“When dealing with women’s health, certain subjects are often considered embarrassing, so we need to ask our WWHAM questions (who is the patient, what are the symptoms, how long have symptoms been present, action taken, medication being taken), to put the patient at ease,” says Amul Mistry, pharmacist at Well. “Using this approach, with open questions and an appropriate level of discretion, means the patient is likely to be more open.”
We may be more open about sex and relationships and even the appearance of our bodies, but there is still a lot of embarrassment around discussing intimate health. Research by Bayer found that 54 per cent of women admit they can’t label all the parts of their anatomy and 41 per cent say they never check their vaginal area. Although 45 per cent say they are concerned about intimate health, 44 per cent would not be able to spot abnormal changes.
The research by Canesten found that many women lack knowledge about common conditions such as thrush, cystitis, bacterial vaginosis (BV) and vaginal dryness, even though 75 per cent experience them at some time. The reason may be because 76 per cent of women say they were never specifi cally taught about intimate health when growing up.
One in seven women believes that thrush is caused by poor hygiene, while four in fi ve are unaware that over-zealous washing, douching and using scented products can cause infections. One in three women doesn’t know what BV is and 71 per cent think vaginal dryness only causes sexual problems, not discomfort. This lack of education means that many women fail to recognise or seek help for intimate health problems quickly enough – 27 per cent said they had used deodorant or perfume to disguise the odour of BV rather than seeking help. Even when women are aware of a problem, two-thirds still feel embarrassed discussing it, while one in 10 feels more self-conscious dealing with vaginal infections than an STI.
“Many women are still in the dark about their own intimate health, confused about the causes and too embarrassed to seek the right advice, resulting in misconceptions about common conditions,” suggests Tania Adib, a gynaecologist who worked with Canesten on the research. “I would urge women to be more comfortable and aware of their own bodies, so they know what’s normal to them.”
She stresses the important role that pharmacists can play in education and advice. “It is very important we continue to drive positive conversations around intimate health conditions, so women become better educated and more confident, so they get the right advice and treatment, when they need it,” she says. “For those who may be confused, I would advise speaking to their local pharmacist, who can provide expert advice and treatment solutions for a range of common intimate health conditions.”
“Thrush is the largest subcategory within women’s intimate health, and cystitis is also a core subcategory,” says Ms Crossthwaite. “Within our retail categories, we class feminine hygiene and bladder weakness as a separate category, but combining with women’s intimate health will help customers to easily find the products they need.”
While the copper IUD is the most effective method of emergency contraception, 95 per cent of women are issued the morning-after pill when they access EC. Pharmacy is the fi rst stop for EC for 77 per cent of women, says Emma Marsh, brand manager for ellaOne at HRA Pharma. “The pharmacy is often the fi rst port of call for women seeking EC, making this an important service delivered by pharmacy within the community,” she says. “It is imperative that pharmacists and their teams understand the important role they play in its effective and consistent provision,” she says.
Discussing emergency contraception can be an uncomfortable experience for women. “Pharmacy team members can ensure women feel supported and not judged, as familiar and friendly faces in the community,” says Ms Marsh.
A lack of key nutrients could be contributing to many women’s health issues, suggests clinical nutritionist Suzie Sawyer, co-author of the report ‘Is the UK heading for a health breakdown?’ produced on behalf of Alive! supplements. “Some 32 per cent of women aged 19 to 64 are deficient in vitamin D, which will potentially impact future health, particularly bones and immune system. Some 45 per cent are deficient in folate, which is important for those of childbearing age, while 48 per cent of girls and 27 per cent of women are low in iron,” she says. “Some 73 per cent of women don’t eat five portions of fruit and vegetables a day.”
When it comes to giving advice about nutrition and supplements to bridge any gaps, pharmacists are well placed. “The women’s health market is clearly one that will benefit from sound advice on supplementation from pharmacists,” says Ms Sawyer.
“It would be useful if pharmacists and staff were given some nutritional training from product specialists on the most common health conditions that women present with, for example nutrients that can ease menopause, PMS or UTI symptoms,” says clinical pharmacist Mike Wakeman, co-author of the report. “It would also be useful to know which widely used drugs cause nutritional deficiencies.”
A recent survey by the British Menopause Society found that half of women felt negatively about their experience of menopause, while three-quarters said it had caused them to change their life. Almost half had hot flushes and 37 per cent had night sweats and low energy levels. Despite this, a third of women who had experienced symptoms had not done anything to try and reduce them.
A study carried out at King’s College London looked at how menopause affects women at work and whether cognitive behavioural therapy (CBT) can help. The study found that women given CBT exercises to try reported fewer hot flushes/night sweats after five months and better quality of sleep.
“We find that older women tend to be more comfortable talking about their health,” says Ms Bhimbat. “It is important to discuss the individual menopause symptoms your customer is experiencing and give advice accordingly.”
Mintel figures show the ‘sanpro’ market grew by about two per cent last year and is predicted to reach £503 million by 2022. Sanitary pads are the most popular form of protection, and 61 per cent of women use pads with wings and 28 per cent pads without wings. Brand loyalty is high, with 67 per cent of women always buying the same brand.
The tax on sanpro products continues, despite the government having agreed to axe it next year. Several supermarkets, including Tesco, Waitrose and Morrisons, have cut the price of their sanpro products by five per cent to absorb the figure until the tax is removed.
There is a growing interest in reusable sanpro among 30 per cent of menstruating women, says Mintel. Tampons, pads and liners create more than 200,000 tonnes of waste a year, says the Women’s Environmental Network, and all contain plastic. Some 48 per cent of women say they’re concerned about the environmental impact of using sanpro products, says the analyst.
Q How do I prevent cystitis from recurring?
A Give advice on healthy diet, intimate hygiene and drinking plenty of fluids.
Q How do I treat thrush?
A “Questions about thrush are among the most common we get,” says Mr Mistry. “It’s important for pharmacy teams to not just go straight to selling a remedy, but to ask about the underlying cause.”
Q What supplements should I take during pregnancy?
A Make sure you’re up to date with the latest guidelines.
Q What emergency contraceptive options are available?
A “Pharmacy team members should take this opportunity to inform women about the different EC methods available – IUD and oral options – to ensure they are informed about their options before making a decision,” says Ms Marsh.
Q I’ve got back pain and I’m pregnant, what can I do?
A Elvy Mardjono, senior brand manager for Deep Freeze (pregnancy), says: “Mums to be are always concerned about taking painkillers while they are pregnant, but Deep Freeze offers a drug-free choice with its pain-relieving gel, patch and glide-on products. They offer fast-acting, cooling relief applied at the point of pain. They can also be recommended for muscular back pain in pregnancy – and after the baby is born.”
“The issues raised can be sensitive, so providing a confidential advice service is key,” says Ms Crossthwaite. “Treat customers’ requirements with discretion, ensuring they know you’re available should they have any questions, and try positioning self-service information at or close to the fixture for them to read first before speaking to someone,” she suggests.
“It is useful to dual site women’s health on your medicines fixture and within feminine hygiene and bladder weakness to allow customers to access all their intimate needs in one place. “Try to position away from the hustle and bustle of the pharmacy to allow customers to feel comfortable browsing,” says Ms Crossthwaite.
“Reassure customers that many of the symptoms and conditions they experience are common and can be treated over the counter or where appropriate the pharmacy team can refer on to other healthcare professionals.”
“Use your consultation room so you can have a private chat to give more details about the condition you’re presented with,” adds Mr Mistry. “Ensure your customer has privacy to discuss her concerns,” says Ms Bhimbat.
“Staff training is key. Staff need to be equipped to hold sensitive and difficult conversations surrounding women’s health and empowering them with knowledge will give them the confidence to do this,” comments Ms Khan.
“Ensure clear signposting is in place to inform women of the services available, including access to emergency contraception,” suggests Ms Marsh. “It will reassure them they have come to the right place.”
“Women are more likely to come and ask for advice or products. They are more open, confi dent and willing to ask for help and advice when it comes to minor ailments. The most common queries are about thrush, cystitis, insomnia, period pain, and weight loss. Our most successful products are brands such as Canesten, self-tests and oral capsules. Sales have increased as more women become aware that treatment is available without a visit to the GP, and there are opportunities to grow this category. Creating a designated women’s zone within the GSL area is a great way to raise awareness, highlighting products and the conditions that these can treat. Staff should be aware of sensitive issues that women may ask about that require private consultations.”
“Women are such important customers because when they come in you’re often giving advice and treatment for the whole family too. The most common queries we get are about pregnancy, menopause, sexual health, post-natal care and intimate health. We’re also seeing more women coming in and asking for advice on losing weight and also giving up smoking in pregnancy. Menopause is a huge growth opportunity for pharmacy and we see increased interest every time there’s a new product in this area. Products for period pain are another growth area. It’s important to display a notice to customers that we treat what they say in confi dence and that we have a private consultation area.”
“Being in a health centre, common questions from women can range from daily dietary aids to advice about contraception or prescribed medication and side effects. Our team are well trained in providing advice around cystitis – local GPs in the health centre refer patients directly to the pharmacy for advice if they are unable to get appointments to understand the severity of the presentation and then the pharmacy can refer accordingly. There are many opportunities to offer lifestyle advice and to provide support on common conditions. In our pharmacy, we group together the women’s health products to make it easier for customers to find what they need. This can also help with repeat custom.”